Provider Demographics
NPI:1568558096
Name:JACKSON, PAMELA S (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:S
Last Name:JACKSON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3299 TOWER RD
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:IN
Mailing Address - Zip Code:47630-8301
Mailing Address - Country:US
Mailing Address - Phone:812-858-8080
Mailing Address - Fax:812-858-8089
Practice Address - Street 1:3299 TOWER RD
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:IN
Practice Address - Zip Code:47630-8301
Practice Address - Country:US
Practice Address - Phone:812-858-8080
Practice Address - Fax:812-858-8089
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28096523A163W00000X
IN71004775A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse